Provider Demographics
NPI:1396581401
Name:RIGGS, KELLY (PNP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:RIGGS
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8551 W LAKE MEAD BLVD STE 180
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-7649
Mailing Address - Country:US
Mailing Address - Phone:702-750-1230
Mailing Address - Fax:
Practice Address - Street 1:8551 W LAKE MEAD BLVD STE 180
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-7649
Practice Address - Country:US
Practice Address - Phone:702-750-1230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV877322363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics